What are the anatomic, physiologic, and hemodynamic determinants of progressive tricuspid regurgitation?
In this narrative review, the complex relationship between the tricuspid valve apparatus and structure and function of the right side of the heart are described, as well as pulmonary vascular hemodynamics, starting with the anatomic construct, which determines these interactions. Abnormalities of any component can lead to a cascade of events that result in progressive tricuspid regurgitation.
Understanding the pathophysiology of tricuspid regurgitation gives insight into clinical outcomes and the timing of interventions.
Severe functional or secondary tricuspid regurgitation (TR) is associated with poor long-term outcomes in natural history studies as well as specific disease states. An understanding of the physiologic causes of the TR is lacking precluding a systematic approach to treatment.
The complex anatomic relationship between the tricuspid valve apparatus and structure of the right side of the heart lends insight into the functional changes seen with secondary TR. The association of these changes with changes in pulmonary vascular hemodynamics can lead to a cascade of events that result in disease progression.
Conclusions and Relevance
Appreciating the role of pulmonary vascular hemodynamics on right ventricular and tricuspid valve morphology and function improves our understanding of the pathophysiology of secondary TR. The limitations of current therapeutic approaches for secondary TR have stimulated interest in improving outcomes with this morbid disease. Changes in timing or approach to intervention require a more comprehensive understanding of the pathophysiology.
Hahn RT, Waxman AB, Denti P, Delhaas T. Anatomic Relationship of the Complex Tricuspid Valve, Right Ventricle, and Pulmonary Vasculature: A Review. JAMA Cardiol. 2019;4(5):478–487. doi:10.1001/jamacardio.2019.0535
Artificial Intelligence Resource Center
Customize your JAMA Network experience by selecting one or more topics from the list below.